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General NPI Number Information
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NPI Number | 1821965161
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Entity Type | Organization
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Legal Business Name | ECCENTRIC THAI MASSAGE LLC
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Dates
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Enumeration Date | 10/21/2025
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Last Update Date | 10/21/2025
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Provider Practice Location Address
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Address Line | 91-3575 KAULUAKOKO ST UNIT 1403
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City | EWA BEACH
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State | HI
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Zip | 96706-5859
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Country | US
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Telephone | 808-699-9971
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Fax | 808-699-9971
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Provider Business Mailing Address
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Address Line | 91-3575 KAULUAKOKO ST UNIT 1403
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City | EWA BEACH
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State | HI
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Zip | 96706-5859
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Country | US
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Telephone | 808-699-9971
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Fax | 808-699-9971
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Authorized Official
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Title or Position | CEO
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Name | MRS. MATTHALIYA AMASULA
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Credential | MAT-16658
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Telephone | 808-445-1768
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State |
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